Understanding IBS

An understanding of the drivers of this complex condition might be key to helping you to manage the symptoms with confidence, says Jane Hickey

Understanding Irritable Bowel Syndrome might be the last thing on your mind when you’re experiencing the distressing symptoms of the condition and you just want it to go away. But an understanding of the drivers of this complex condition might be key to helping you to manage the symptoms of IBS with confidence.

A common condition

IBS, one of the common gastrointestinal disorders, affects up to 20% of the population, mainly in the 20-39 year age group, and more commonly affecting women.

The symptoms of IBS, which tend to come and go and may last for days, weeks or months, are stomach pains and constipation or diarrhoea. Bloating may also be experienced. A diagnosis of IBS is normally made after other conditions with similar symptoms (such as Inflammatory Bowel Disease or Coeliac Disease) have been ruled out. IBS has been characterised by a lack of detectable changes in the body.

One person’s experience of IBS may be quite different from another person’s experience, as symptoms are highly individual. While many people do not seek medical help and choose to self-manage the condition, anyone with signs or symptoms causing them concern is advised to talk to their GP.

Frequently there is no clear cause for IBS, but an episode of gastroenteritis may be the trigger for post-infectious IBS.

A revised classification

Previously considered a “functional gastrointestinal disorder”, IBS was reclassified in 2016, highlighting the significance of the gut-brain axis in IBS.

The gut-brain axis is made up of a complex network of communication in both directions. This interaction takes place between the central nervous system, the autonomic nervous system (especially the vagus nerve) and the enteric nervous system. These links explain the connection between emotions and gut health.

Stress is a normal part of life, but some people may have heightened responses to stress, because of past trauma or because of an increased sensitivity. There is a link between stress and IBS. The experience of IBS is stressful. Stress may affect gastrointestinal functions, making symptoms worse. Stressful events may also be implicated in the development of IBS.

The microbiome-gut-brain axis

An essential part of the gut-brain axis is the gut microbiome. The microbiome interacts with the enteric nervous to support balance and stability in the gut. A state of dysbiosis, when the balance of the microbiome is disturbed, has an impact on the enteric nervous system and on the bi-directional interaction between the gut and the brain, upsetting gut functions.
With IBS now classified as a “disorder of the gut-brain axis”, the microbiome also plays a vital role in the microbiome-gut-brain axis.

Food and IBS

It is instinctive to avoid foods which are triggering any symptoms. In the immediate term this makes sense with IBS. In the longer term, a systematic approach and detailed assessment is more helpful to manage symptoms and to ensure a nutritionally beneficial diet.

A low FODMAP diet is often recommended for IBS. This is best followed with support from a trained practitioner. FODMAP refers to specific types of carbohydrates which may be difficult to digest and trigger symptoms. While this may be helpful in the short term, it is not recommended as a long term solution as it is likely to lead to nutritional deficiencies.

Foods which may be helpful for some symptoms of IBS are those high in soluble fibre, but these need to be introduced gradually and with adequate hydration. Probiotics may also be helpful for IBS, supporting a healthy microbiome.

A holistic approach to IBS

The complex nature of IBS benefits from a range of therapeutic support to suit specific symptoms. Diet and lifestyle are foundational to managing the symptoms of IBS. Also likely to be helpful are techniques to support emotional health, such as mindfulness and relaxation.

Nutritional therapy for IBS is a highly personalised approach to identify the most beneficial diet and lifestyle choices, with a step by step approach to introduce helpful changes, restoring the health of the microbiome, with a review process to create an ongoing maintenance plan.

A range of therapies support emotional health, such as hypnotherapy or cognitive behavioural therapy, with some focussed therapies for IBS.

Jane Hickey is a registered nutritional therapist and a health and wellbeing coach, with a special interest in IBS. She sees clients at the Practice Rooms in Bristol and Cheltenham, and online – janehickeynutrition.com